Sex Problems in Men: Impotence (ED), Premature Ejaculation and What Genuinely Helps

Let's talk about it

Eight months, three "clinics", and one simple answer

Manoj was thirty-four, a cloth merchant from Bihar Sharif, married for six years. He finally came to my clinic after eight months and close to forty thousand rupees spent elsewhere: on a "gupt rog" clinic advertised on a wall near the bus stand, on powders and capsules from another, and on an injection course from a third. His problem had begun after one difficult night when his erection faded. After that, he said, "I was so afraid it would happen again that it kept happening."

Two things were going on. The first was performance anxiety, a very common, very treatable cycle of fear. The second was something none of the earlier "clinics" had checked: his blood sugar was in the diabetic range. Both were fixable. Neither needed secret powders. Men's sexual problems are among the most common health concerns there are, and among the most treatable, but only when they are assessed like any other medical condition.

The five concerns men bring most often

How it works

An erection needs four systems working together

This is the single most useful idea I share with patients. When any one of these four systems is under strain, erections suffer. A good assessment checks all four, which is why no single pill or powder can be "the cure".

Mind or body?

Clues that point towards the cause

Men often ask, "Is it in my head or in my body?" The honest answer is usually both. But a few clues help a doctor decide where to look first.

The performance anxiety trap

An erection is controlled by the "rest and relax" part of the nervous system. Fear activates the opposite side, the "fight or flight" system, which actively shuts erections down. So the more a man worries about failing, the more likely failure becomes. Masters and Johnson called this spectatoring: watching yourself from the outside instead of being present with your partner.¹¹

Breaking the cycle does not mean "trying harder". It means taking the pressure off, and that is exactly what treatments such as sensate focus and cognitive behavioural therapy (CBT) are designed to do. In many men, a short course of medicine helps too, simply by restoring confidence while the fear settles.

Timing, desire and "weakness"

Premature ejaculation: what counts, and what helps

Films and online videos have badly distorted what is normal. In large studies using stopwatches, the average time from penetration to ejaculation was around five to six minutes, with a wide range.⁸ Experts from the International Society for Sexual Medicine define premature ejaculation by three features together:⁷

1. Ejaculation that always or nearly always happens within about one minute (if lifelong) or with a clear, bothersome reduction to about three minutes or less (if it developed later);
2. Little or no ability to delay it; and
3. Distress, frustration or avoidance of intimacy as a result.

Occasional early ejaculation, especially after a long gap or with a new partner, is normal and not a disorder.

What helps: behavioural techniques such as the stop-start and squeeze methods, practised alone and then with a partner; treating any erection difficulty first (men sometimes rush to finish before the erection fades); reducing anxiety; and, where needed, medicines prescribed after assessment, either on-demand tablets from the antidepressant class or numbing creams or sprays used correctly. Over-the-counter "timing" products of unknown content are not a safe shortcut.

Treatment

What genuinely works, and what to avoid

International guidelines from the European Association of Urology and the American Urological Association, and the Indian Psychiatric Society's clinical practice guidelines, agree on the core approach: treat the whole man, start with the safest effective steps, and always look for the cause.¹²³

What to expect

A proper assessment, and how it differs from the bus-stand clinic

1. 1A private conversation

   When it started, in which situations, morning erections, desire, timing, stress, mood, relationship, alcohol and tobacco. Partners are welcome if you wish.

2. 2A health check

   Blood pressure, weight and waist, and a brief physical examination where needed.

3. 3Targeted tests

   Blood sugar and HbA1c, cholesterol, thyroid; morning testosterone and prolactin when symptoms suggest a hormonal cause.

4. 4A clear plan

   An explanation in plain words, lifestyle steps, therapy and medicine as needed, and a follow-up date.

At Healthy Minds India, these concerns are assessed by a psychiatrist in our sexual health clinic in Patna, alongside treatment for psychosexual disorders such as performance anxiety and dhat worry, and CBT and other behavioural therapies. When a physical cause needs it, we work with physicians and urologists.

What happened to Manoj

We stopped all the unlabelled capsules. His diabetes was started on treatment by a physician colleague, and he began walking every morning and gave up gutkha. For the anxiety, he and his wife attended four sessions, including sensate focus, a set of exercises that, for a while, deliberately takes intercourse off the table so that fear can fade. A short course of an ED tablet, prescribed after his heart check, helped restore confidence. Three months later his wife said, laughing, that the hardest part had been "getting him to talk to a real doctor". He agreed.

Bring to your appointment

• A list of all medicines and supplements you take
• Recent blood reports
• How long the problem has lasted and when it happens
• Any questions written down, like the chits below

Nothing you say will shock your doctor. Many men find it easier to write a question than to say it aloud; the questions below are the chits men leave on my desk most often. When you are ready, you can book a private consultation.

Anonymous questions

Frequently Asked Questions

• Is erectile dysfunction permanent?

  Usually not. Most men improve with the right combination of lifestyle change, treatment of the cause, therapy and medicine. Even long-standing ED has effective options.

• Can stress alone cause impotence?

  Yes, especially in younger men. Stress, anxiety and depression are common causes, and very treatable. A health check is still wise to rule out a physical cause too.

• Are ED tablets safe? Will I get addicted?

  Prescribed after a health check, they are safe for most men and not addictive. They are dangerous with nitrate heart medicines, and should never be bought without a prescription.

• Does masturbation cause weakness or ED?

  No. It causes no physical harm. Guilt and fear about it can cause anxiety, which may affect performance; that is the part worth addressing.

• Does watching pornography cause ED?

  The research is mixed. Some men find heavy use changes their expectations or arousal patterns. If you notice a pattern, cutting back for a few weeks is a reasonable experiment.

• Will shilajit or ashwagandha fix my problem?

  There is no good evidence they treat ED or PE, and many such products have been found adulterated. Spend that money on a proper check-up instead.

• Do I need my testosterone checked?

  Only if you have symptoms such as low desire, fatigue or loss of body hair. It must be an early-morning test, repeated if low, before any treatment is considered.

• Should my wife come to the appointment?

  Only if you both wish. Many couples find it helpful: sexual problems affect both partners, and treatment often works better together.

About this article

Written and medically reviewed by

Dr. Saurabh Kumar

• MD (Psychiatry) AIIMS New Delhi
• Associate Professor & HOD, Dept. of Psychiatry, RDJM Medical College, Muzaffarpur
• Ex-Assistant Professor, PMCH Patna
• Consultant, Healthy Minds India, Patna

Published

15 October 2026

Format

Patient guide

Focus

Men's sexual health: ED, PE and dhat worry

Sources

12 references

• Dr. Saurabh Kumar is a psychiatrist who treats psychosexual concerns alongside anxiety, depression and addiction, and works with physicians and urologists when a physical cause needs their care.
• Sensate focus and the concept of spectatoring are from William Masters and Virginia Johnson. The four-systems explanation is a simplification for patients.
• Manoj's story is a composite; case details are illustrative only. Most estimates come from international studies, as Indian data are limited.
• Written for general education. It does not replace an individual assessment by a qualified clinician and does not diagnose any condition. Diagrams are original illustrations prepared for this article.

© 2026 Healthy Minds India, Patna · Blog edition 2.0, October 2026 (revised from the January 2026 web article)